Thursday, June 26, 2008

Resistant Hypertension: Diagnosis, Evaluation, and Treatment, from the AHA

Conventional (mechanical) sphygmomanometer with aneroid manometer and stethoscopeImage via Wikipedia
Resistant Hypertension: Diagnosis, Evaluation, and Treatment: A Scientific Statement From the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research -- Calhoun et al. 51 (6): 1403 -- Hypertension
Resistant hypertension is a common clinical problem faced by both primary care clinicians and specialists. While the exact prevalence of resistant hypertension is unknown, clinical trials suggest that it is not rare, involving perhaps 20% to 30% of study participants. As older age and obesity are 2 of the strongest risk factors for uncontrolled hypertension, the incidence of resistant hypertension will likely increase as the population becomes more elderly and heavier. The prognosis of resistant hypertension is unknown, but cardiovascular risk is undoubtedly increased as patients often have a history of long-standing, severe hypertension complicated by multiple other cardiovascular risk factors such as obesity, sleep apnea, diabetes, and chronic kidney disease. The diagnosis of resistant hypertension requires use of good blood pressure technique to confirm persistently elevated blood pressure levels. Pseudoresistance, including lack of blood pressure control secondary to poor medication adherence or white coat hypertension, must be excluded. Resistant hypertension is almost always multifactorial in etiology. Successful treatment requires identification and reversal of lifestyle factors contributing to treatment resistance; diagnosis and appropriate treatment of secondary causes of hypertension; and use of effective multidrug regimens. As a subgroup, patients with resistant hypertension have not been widely studied. Observational assessments have allowed for identification of demographic and lifestyle characteristics associated with resistant hypertension, and the role of secondary causes of hypertension in promoting treatment resistance is well documented; however, identification of broader mechanisms of treatment resistance is lacking. In particular, attempts to elucidate potential genetic causes of resistant hypertension have been limited. Recommendations for the pharmacological treatment of resistant hypertension remain largely empiric due to the lack of systematic assessments of 3 or 4 drug combinations. Studies of resistant hypertension are limited by the high cardiovascular risk of patients within this subgroup, which generally precludes safe withdrawal of medications; the presence of multiple disease processes (eg, sleep apnea, diabetes, chronic kidney disease, atherosclerotic disease) and their associated medical therapies, which confound interpretation of study results; and the difficulty in enrolling large numbers of study participants. Expanding our understanding of the causes of resistant hypertension and thereby potentially allowing for more effective prevention and/or treatment will be essential to improve the long-term clinical management of this disorder.
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Tuesday, June 24, 2008

Gastric Bypass May Improve Renal Function in Obesity Related Glomeruopathy

Roux-en-Y gastric bypass.Image via Wikipedia
Gastric Bypass Can Improve Renal Function in Patients With Morbid Obesity, Via Medscape:
Patients with morbid obesity who also have chronic renal disease (CRD) may improve or stabilize renal function after gastric bypass, according to a study presented here at the American Society for Metabolic & Bariatric Surgery 25th Annual Meeting.
[Interesting. Obesity related glomerulopathy is mediated by hyperfiltration, which might theoretically be reversible with gastric bypass.]
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Monday, June 2, 2008

Life Hacks for Doctors: An Introduction

The Efficient MD Blog
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Life Hacks for Doctors is the Slideshow of the Day on Slideshare

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Nice start to the week. On the home page, Slideshare also highlights other slideshows on Doctors, Medicine, and Web 2.0.

Sunday, June 1, 2008

Manhattan Solstice